扩张皮瓣延迟术在面颊部大面积瘢痕治疗中应用.docVIP

扩张皮瓣延迟术在面颊部大面积瘢痕治疗中应用[摘要]目的：探讨扩张皮瓣延迟术在面颊部大面积瘢痕治疗中的应用效果及其优越性。方法：17例面颊部大面积瘢痕患者，于同侧颈部、耳前、额部正常皮下置入一个或多个扩张器，容量8O～5OO ml。1～3个月皮瓣充分扩张后，对超长宽比例（≥3:1）或扭转角度过大的行延迟术。术后2～3周行扩张器取出、瘢痕切除、皮瓣转移。结果：17例扩张皮瓣术后未见动脉供血和静脉回流障碍，皮瓣全部成活，皮瓣色泽、质地较好，外形美观。结论：扩张皮瓣延迟术使皮瓣血管方向和管径发生改变，使皮瓣更安全转移，不易发生血运障碍，在面颊部大面积瘢痕治疗中取得良好效果。 [关键词]扩张器；面颊部;大面积瘢痕；延迟；扩张皮瓣 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2007）09-1192-03 Clinical application of delaying of expanded skin flap used in repairing large cheek scar defect WU Hao-jun,ZHANG Gang,LIANG Jie,HAO Xin-guang （Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang 524023,Guangdong, China） Abstract: ObjectiveTo study the superiority and results of delaying of expanded skin flap used in repairing large cheek scar defect.MethodsOne or several soft tisse expanders were implanted under the hypo of cervical part or preauricula region or frontal region near the scar. the expanded flap delaying operation was performed After the skin flap was expanded. 2～3weeks latter,the flap was transferred to coverthe wound on the recipient area. the wound on the donor site was closed directly.ResultsFrom 2003 to 2006,this technique was used in 17 patients.the flaps were completely survived after operations.ConclusionDelaying of expanded skin flap is a kind of technique with good flap blood supply,large area of flap and suitable flap thickness. it is an effective and practical approach to resconstruct the large cheek scar defect. Key words: soft tisse expanders; cheek scar; delaying; expanded flap 面颊部是人体外露部位，伤后形成的瘢痕不仅影响美观，严重者可导致颜面器官的畸形。对瘢痕切除后的缺损修复方法较多，如直接缝合、皮片移植、局部皮瓣转移、远位皮瓣移植等，但这些修复方法均存在不同缺点。皮肤扩张术自从在临床广泛应用以来，已成为颜面瘢痕切除后创面修复的首选方法之一。但扩张皮瓣转移后仍有出现血运障碍可能，尤其是皮瓣超长宽比例（≥3:1）或扭转角度过大时，常引起皮瓣远端坏死，需二期修复或致瘢痕形成，影响手术效果。我科自2003年9月至2006年10月采用扩张皮瓣延迟术共17例，术后未见动脉供血和静脉回流障碍，皮瓣成活率100%，在面颊部大面积瘢痕治疗中取得满意的效果，现总结如下。 1临床资料 本组患者17例，男性6例，女性11例。年龄最大45岁，最小16岁，平均23岁。均为烧伤后面颊部瘢痕形成，时间为1～14年。瘢痕最小6cm×5cm，最大15cm×12cm。扩张器容量8O～5OOml，扩张器置入位置：颈部、额部、耳前。如面颈部没有足够正常皮肤，可置入肩、前胸部。